As children in your community participate in this year’s trick-or-treat, many will shriek with excitement from the scary costumes, ghoulish décor and other
Halloween horrors. The day after, the frightening excitement will melt away and children will return to their usual fall time schedules. But for thousands
of children with anxiety in the United States, dealing with real fear
every day of the year is reality.

Anxiety in children might not always appear in the way you’d expect. “A lot of children will describe feeling tense or parents will notice their child
losing weight due to a loss of appetite,” says Cuong Tieu, MD, medical director of the
residential Child Center, located on the Rogers Memorial Hospital–Oconomowoc campus. “Children may also complain about having an
upset stomach, sweaty palms, racing heart, diarrhea or difficulty breathing, while teenagers tend to report feeling worried or afraid of certain events.”

But what are kids with anxiety afraid of? “Pediatric anxiety varies by child and can range from specific phobias about the dark or heights to separation
from parents,” says Dr. Tieu. “Anxiety depends on our life experiences and how we perceive threatening or provoking events in our lives, as well as our
genetic makeup.”

Pediatric anxiety rises above the occasional bad dream or worry about a monster in the closet. “All children experience anxiety at some level, but it’s how
they manage it that’s important,” says Dr. Tieu. “We’re concerned about the type of anxiety that causes a child to shut down or fall short of their
academic, social and family potential.” The sooner a child or teen begins treatment for anxiety and learns healthy ways to express emotions, the more
likely they will be able to successfully manage the anxiety into adulthood.

“The demoralizing, negative experiences a child has as a result of their anxiety simply fuel and reinforce avoidance behaviors, causing anxiety to worsen
over time because it’s not being addressed,” says Dr. Tieu. “With the help of the treatment team and evidence-based exposure therapy, children can create
positive experiences by learning to control their anxiety with coping skills.”

Sometimes, parents believe their child will simply grow out of their anxiety. “Oftentimes, a parent has had their own anxiety since childhood, which is why
they may minimize their own child’s symptoms or believe they can learn to manage it on their own,” says Dr. Tieu. “It’s a huge moment in therapy when a
parent realizes how differently their adult life may have been if they had access to the treatment their child is receiving.”

As a parent, what should you do if you believe your child may have an anxiety disorder? Dr. Tieu recommends collecting observationson
your child from multiple sources and in many different settings. “Parents have experience with their child in one primary setting: the home,” he says. “So
it’s good to explore other settings. Talk with your child’s teachers, other parents and family members who are involved in your child’s life.” If
anxiety-related behaviors are present across these different settings, Dr. Tieu recommends reaching out for professional treatment.

“Symptom accommodation is the actions taken by parents, siblings, family members, friends, teachers and anyone who unintentionally reinforces a person’s OCD by catering to their anxiety,” says Stephanie Eken, MD, regional medical director at Rogers Behavioral Health. “Research tells us that at least 70% of parents or family members engage in symptom accommodation and I would say much of the remaining 30% probably aren’t aware they are accommodating.”

Common ways in which parents participate in symptom accommodation include:

Allowing a child to miss an activity because they’re anxious about it

Participating in a child’s ritual for them, checking and re-checking that doors and windows are locked

Assisting in a child’s ritual, purchasing a certain brand of soap in bulk at the child’s request or opening a door for a child who is afraid of contamination

Providing reassurance, answering a child’s repetitive questions to their exact standards, even if you don’t know the answer

Waiting for a child’s rituals to be completed or changing your schedule

Decreasing the child’s age-appropriate responsibilities, doing chores or homework for them

Parents accommodate for a variety of reasons. “Many parents have provided reassurance to their children without OCD and it worked for those kids,” says Dr. Eken. “But for children with OCD, providing reassurance is a time-consuming bottomless pit and will only fuel the child’s anxiety in the long-run.” Parents are also more likely to accommodate if their child has severe OCD symptoms or a disruptive behavior disorder, such as ADHD; there is a high amount of stress in the family; or if one or more of the parents has OCD.

In the beginning, parents may think they’re being too harsh for reducing their accommodation—or that’s it’s easier to soothe their child’s anxiety in the moment, especially if they’re having an outburst. “Several studies have shown that symptom accommodation can worsen or maintain a child’s symptoms because they’re never able to experience habituation,” says Dr. Eken. “When a child habituates, they get used to their anxiety over time and realize they have the ability to ride it out, without using their compulsion.”

Those with higher rates of family accommodation are also at a higher risk of having refractory OCD. “Refractory OCD is difficult to treat OCD and patients may not experience as great of symptom reduction,” says Dr. Eken. “But once families engage in cognitive behavioral therapy (CBT) treatment and ERP, accommodation tends to decrease because it’s something we purposely discuss.”

So what should parents do? “At Rogers, we like to talk about parents as coaches,” says Dr. Eken. “When parents, the child and the therapist are a united front against OCD, the child can more easily receive motivation and consistent messaging. Parents help their child complete gradual exposures and process that their anxiety isn’t dangerous. It doesn’t feel good, but it can’t hurt them.”

It’s also important for parents to find time for themselves. “Reading a book, going on a date, doing something that has nothing to do with your child can help you be more present and energetic during treatment,” says Dr. Eken. “Support groups can also be helpful and allow parents to share their challenges and successes with others who understand their struggle.”

“Because every patient is dealing with opioid addiction, they can thoroughly relate to one another without judgment,” says Jeff Schroeder, alcohol and drug
addiction counselor at Rogers–Brown Deer. “Opioid addiction is different from alcohol or other addictions and Rogers specializes in treating it.”

In a program like this, patients receive a comprehensive, evidence-based behavioral therapy treatment plan in combination with buprenorphine/naloxone.
While other medications for opioid addiction are offered to patients in Rogers’ other, specialized outpatient programs for addiction and dual diagnoses,
patients in the opioid IOP-MAT program are exclusively on preparation of buprenorphine/naloxone. This allows each patient individually to develop the
foundation to prevent relapse and address obstacles to recovery.

Schroeder explains the program has experienced a spike in the number in patients seeking treatment earlier in their addiction, typically three to four
years. “As compared to patients who have been addicted for 10 to 15 years, these patients often don’t feel the need to go to the same lengths in treatment
because they haven’t experienced the same number of consequences,” says Schroeder. “This unique, eight-week program helps break down that minimization and
denial.”

In addition to medication and therapy, family participation in bi-weekly education sessions has also been a key aspect of patient success for this new
program. “Families are more connected to their loved one because they get a better idea of what they’ve been going through and how they can help them get
well,” says Schroeder. “It also makes relapse less likely and supports more open communication between the family and patient.”

Tatjana Barisic-Dujmovic, MD, adult psychiatrist at Rogers–Brown Deer, says continuing care with outpatient programs that incorporates medications for opioid addiction is key. “When
we have a referral from the community or one of our inpatient units, we do our best to admit that person into IOP immediately when they are seeking help,”
she says. “If we don’t, they are more likely to relapse and feel that treatment is not accessible. Patients initiating treatment on their own is so
precious that we want to use that opportunity to further engage them. It takes lots of courage to seek treatment.”

A psychiatrist sees patients upon starting the program, and will induct the patient on a buprenorphine/naloxone combination. This helps the patient cope
with opioid withdrawal symptoms and cravings so that they can focus on learning coping skills in the group.

The opioid addiction program is longer in length – about eight weeks – than other intensive outpatient programs. “Our patients find it beneficial and would
actually prefer to continue with the program even longer. For that reason alone, the program could be called a success,” says Dr. Barisic-Dujmovic. “And
even though this is a difficult time, the majority of patients establish supportive relationships with one another and encourage each other to attend
community meetings after leaving Rogers.”

Other MAT program options are available in various levels of treatment at Rogers’ locations in:

“We’re so excited for Rogers–Brown Deer to be a part of this program and get to know our students on a personal level,” says Carole Carter-Olkowski,
academic and community engagement liaison at Rogers Memorial Hospital. “Our two high school freshmen and two sophomores are helping out in our staff
development, purchasing and dietary and food services departments.”

According to staff, the Cristo Rey students and their enthusiasm have been a breath of fresh air. “They have been excellent,” says Ryan Geller, manager of
culinary and nutritional services at Rogers–Brown Deer. “They have spent their first few weeks learning about Rogers and our services, along with what goes
into the daily operations of a hospital.”

The students’ tasks include cost comparison, data entry, spreadsheets and invoices; filling orders; making deliveries; helping facilitate employee
orientations and other administrative duties. “Often when students consider healthcare positions, they think they can only be a doctor or nurse,” says
Carter-Olkowski. “But this program allows them to see the variety of positions involved in healthcare—especially the behavioral aspect—such as social work
and counseling.”

Cristo Rey reports 32 percent of their 2008 graduating class have earned bachelor’s degrees, which is twice the national average for low-income students.
“It’s important for us to help develop their skills, build their resumes and motivate them to attend college,” says Carter-Olkowski. “If they already have
a sense of a career path they’d like to take and solid work experience, they’re more likely to finish college.”

But how do high school students prepare for these positions? In a five-week summertime business boot-camp, students receive training at Manpower, a human
resource consulting firm. “Many of the students are already computer savvy,” says Carter-Olkowski. “But through Manpower, they receive additional technical
classes in Excel, Word and Outlook, as well as confidentiality training through OSHA. At Rogers, they continue their training and gain lifelong skills.”

This August, Cristo Rey held a sports-inspired Draft Day, a special event where students found out which businesses they would work for. “To make sure each
student has a positive experience, they complete a resume describing their interests and previous work history, and Cristo Rey matches them with an
employer,” says Carter-Olkowski. “It was a really special day and we made Rogers hats and t-shirts with their graduation dates on the back.”

For Rogers, the Cristo Rey program offers a way to develop and keep valuable talent. “Next year, the students will decide if they’d like to remain at
Rogers or experience a new business,” says Carter-Olkowski. “Sometimes, businesses offer their students internships or part-time positions because they’re
so pleased with their work.”

Next year, four to five teams of students will also work at Rogers–Oconomowoc. “Now that
more businesses in the area are participating, Cristo Rey will be able to bus students further west,” says Carter-Olkowski. “Our Oconomowoc managers have
shown high interest in the program and we’re considering positions in our human resources, staff development and revenue cycle departments.”

Before officially joining the program, Brown Deer staff members were able to hear from Cristo Rey graduates who are now employed locally, as well as from
employers who participated in the program last year. “It’s so inspiring to see the program keeps giving back to the kids,” says Carter-Olkowski. “The
students build lasting relationships with their employers and as one of the leading behavioral health systems in the United States, I’m proud we can give
back to the community in this way.”

Overall, there is a sense of excitement for what this new partnership will bring, especially among the students. “Everyone is very welcoming and take their
work seriously,” says Jacki, a Cristo Rey student. “I really respect the work they do here at Rogers and I know this experience is going to be one for the
books.”

While methadone, naltrexone and other medications were approved decades ago to treat alcohol, opioid and tobacco use disorders in the United States, the controversy surrounding their
inclusion in treatment plans unfortunately still remains.

Some clinicians believe medications are never appropriate and they simply substitute one addiction for another. Some grudgingly accept them as part of
current approaches. Others view them as a major advance and new opportunity that wasn’t previously available to help individuals with substance use
disorders. However, recent research and policies from professional and government organizations, such as the American Society of Addiction Medicine (ASAM) and National Institute on Drug Abuse (NIDA), explain the best patient results occur when integrating medications and psychosocial treatments. In short, these methods are
better together and the mindset that one is the right method is not helpful.

Currently in the United States, most residential facilities for substance use disorders treatment don’t allow medications and some feel very strongly about
defending the 12-step recovery method. At Rogers’ residential Herrington Recovery Center, we incorporate the 12-step recovery method and encourage
involvement in 12-step groups. But, we also offer other evidence-based therapeutic methods in combination with medication management
because we believe addiction treatment should not be an either/or approach to care.

Supporting the patient

We clinicians realize that many people with a history of prescription drug abuse don’t trust themselves with medications because they’re afraid they’ll lose
control. But with structure and support from a well-informed treatment team, patients will be able to develop the confidence they need. Talking out the
situation with the patient is also helpful, because it decreases the chances that he or she will act on those thoughts.

So how can we, as clinicians, provide the support our patients need and develop a balanced method for prescribing opioids? The AMA suggests developing a
clear understanding of:

Of course, no one treatment works for every patient and medications are absolutely not a universal solution. Doing the hard work of therapy in combination
with medication is the best, scientifically proven approach.

“It was an honor for Rogers InHealth to receive recognition from HBI, considering their reputation for spreading best practice research and implementation
resources across the healthcare industry,” said Suzette Urbashich, co-director of Rogers InHealth. “It’s a sign that we’ve been using an effective method
to help people improve their outlook on mental health and eliminate the shame or stigma they were once challenged with.”

TLC4, the evidence-based model InHealth is based in, was originally created by the Illinois Institute of Technology and partnering behavioral health organizations. “TLC4 stands for: targeted, local,
credible, continuous and change-focused contacts,” says Urbashich.

Targeted Contact
For people to feel comfortable reaching out for support and resources, our community must become aware of their biases toward people with mental health
challenges. “People tend to experience stigma in different sectors of the community, such as a health care, faith-based, schools, workplace or civic
groups,” says Sue McKenzie, co-director of Rogers InHealth. “Identifying sectors of our community that have a big impact on people’s lives and then
targeting efforts to work directly with these sectors is crucial to any effort to increase inclusion and effective support.”

Local Contact
Every person has a method for learning which works best for him or her, because we process information differently. For InHealth, that means tailoring
their approach for the various groups they serve. “One approach for reducing mental health stigma may not translate the same in a different community,”
says Urbashich. “For example, we’re going to create a much different plan for Crivitz than we would for Racine, based on the different cultures of those
communities.”

Credible Contact
Whether discussing mental illness or another topic, it always helps to talk to someone who genuinely understands what you’re feeling. “As humans, we’re
more likely to accept what someone has to tell us when it comes from a trustworthy peer,” says McKenzie. “Someone who is a member of the targeted group
will have the most profound impact on the rest of the group and will more easily shift others toward a more recovery-focused way of thinking.”

Continuous Contact
“When you’re trying to change the way you’ve been thinking about mental health for years, it takes more than just one event to change your mindset
for life,” says Urbashich. Continuous contact emphasizes planning that offers many opportunities to get to know people in recovery over an extended period
of time as a way to effectively change the way you perceive those with mental health challenges.

Change-focused Contact
The real test to determine if the targeted group has reduced their stigma during the process is to see if they act differently. “We might encourage a group
to partner with local mental health groups, host a support group, or participate in another activity that has them spread the message they’ve come to
accept,” says McKenzie.

“As we’ve offered consultation on the application of the TLC4 model to communities, they have found it to be very helpful guidance as they make plans to
increase inclusion and support for all facing mental health challenges,” says Urbashich. “We’re looking forward to the positive mental health stories we’ll spread and the lives we’re going to touch in the future.”

The award recognizes Thomet’s advocacy and dedication to individuals with mental illness and addiction through more than 20 years of service at Rogers
Memorial Hospital. As the marketing liaison for the International OCD Foundation (IOCDF), he’s made it his personal
mission to acquire as many resources as possible to improve the lives of children, teens, adults and families affected by obsessive-compulsive disorder (OCD).

“Over the years, Barry has blazed a trail,” says Stacy McGauvran-Hruby, director of marketing at Rogers. “He served as Rogers’ first community outreach
representative and spread the word about Rogers’ first OCD partial program, contributing greatly to the record number of people served.”

Not only is Barry invaluable to those he serves, but he’s a joy to his colleagues. “Barry’s overflowing, warm personality is contagious and his passion for
helping those in need is inspiring,” says Jerry Halverson, MD, medical director of Rogers Memorial Hospital. “He’s gone above and beyond to ensure families experiencing a mental health crisis receive a clear picture about what
they can expect in treatment at Rogers, as well as other local and national providers.”

“A little known aspect of Barry's work is that he is a great steward of treatment in general, not just Rogers,” says Paul Mueller, chief executive officer of Rogers Memorial Hospital. “His lightheartedness is
complemented by the gentle demeanor he has with those who reach out to him. He knows the difficulty and challenges that individuals with OCD and other
mental illnesses face, which makes him one of the best resources for guidance and understanding.”

“It’s said that ‘everyone knows Barry,’” adds Mary Jo Wiegratz, national outreach manager.
“Whether talking with a caller on the phone, touring a visitor, or connecting with patients and professionals who see his friendly face at the IOCDF annual
conference, Barry Thomet has touched a lot of lives and made a difference.”

Theresa Rogers understood the benefits of gardening in the healing process. The wife of Rogers’ founder, Mrs. Rogers created a magnificent garden which, in
the 1920s, drew busloads of people to visit what is now Rogers Memorial Hospital–Oconomowoc. Rogers was known throughout the Midwest for its beautiful
landscaping and two miles of natural gardens.

Rogers Memorial Hospital circa 1920.

Mrs. Rogers planted a living legacy which endures today. However, it took the perseverance of Rita Nolte to return the gardens to their glory and set the
stage for an even greater vision which continues to evolve.

When Rita joined Rogers in the 1990s as a patient assistant, the gardens were dreadfully unkempt. She wanted our patients to have a serene view that could
bring peace to their often chaotic health situations.

Moving Into Action

In 1990, Rita’s role was to monitor her patients’ emotions and assist in therapy. She would often look out the windows of the main hospital down into what
was then called the kitchen garden, which was filled with raspberries, rhubarb and other produce grown in the era of Dr. and Mrs. Rogers.

But in 1990, the kitchen garden had grown wild. Rita was worried about what patients and visitors would think of the sight. “When patients are in distress,
they don’t need more chaos,” she says. So, beginning in 1991, the then-patient assistant began volunteering two hours per day, two days per week pulling
weeds with her own tools in what is known today as the center courtyard.

Finding Others Who Believed in the Mission

In 1992, Rita found two volunteers; she needed additional hands if big changes were ever going to be accomplished. “They did this all on their own time,”
she says. “It was a real commitment by people who saw the spiritual nature of gardens, plant materials and how it could renew people,” she says.

Volunteers were given a free plant for every 2 hours of their time. “That particular practice is what I used throughout the rest of the restoration
process,” she says, “If people helped, they went home with a plant.”

Rita took on another garden in 1993 located next to an old barn on the property, while still continuing to work on the center courtyard. By this time, Rita
formed a sub-committee of volunteers and began planning a barn sale in September of that year to collect funds.

By 1994, Rita was forming a new dream and began collecting input for redesigning Rogers’ largest gardens—the Theresa Rogers Gardens. She formed a full
committee to create an implementation process and in April, they held their first official meeting. By May, the center courtyard was complete and had a
vegetable garden, grass center, flower bed and picnic tables for staff and patients to eat their lunches and enjoy the peaceful natural space. It was a
total transformation from the weed-ridden patch Rita once looked at from the hospital’s window.

One of the original urns.

At the end of May, Rita spaded and weeded the front yard of the hospital. She planted flowers in two large empty concrete urns sitting at the hospital
entrance, which were original to the grounds. Today, the urns, other original pieces and plants can be found in the Theresa Rogers Garden.

The Infancy of Horticultural Therapy at Rogers

In March 1995, Rita was approached by leaders of the adolescent residential program who found many teens enjoyed the outdoors and wanted to help Rita
garden.

“Spending time in the environment was enjoyable for the patients,” she says. Adolescents wanted to help with everything from hauling brush to pulling
weeds, all to enjoy the benefits of fresh air and planting.

Rita Takes her Cause to the Board

Rita made an appointment with the Rogers Memorial Hospital Board in April 1995 as her funds from the barn sale were quickly dwindling and she needed
additional help to continue restoring the gardens to the original splendor that Theresa Rogers created. She explained her philosophy to the board, as well
as the healing and spiritual properties of the gardens, saying, “We have 56 acres of property, we have trees, we have lake frontage, we have small ponds,
but we have rack and ruined gardens.”

To Rita’s surprise, the board awarded her a large contribution for the renovation, which greatly surpassed her initial goal. She used these funds to
maintain the landscapes she had created and worked diligently with patients and volunteers to keep up with the gardens.

In 1999, Nolte was awarded an even larger donation from the board and finally had enough funds to begin carrying out her master plan for the Theresa Rogers
Gardens, which included a traditional English style matching the heritage of Dr. and Mrs. Rogers. The design process began that year and was developed by
Margaret Harvey, landscape architect of Milwaukee, Wisconsin, and Dorset, England.

Keeping the Gardens Traditional

Like Dr. and Mrs. Rogers, Rita has English heritage. In 2000, she traveled to England for an authentic experience of English culture and to study the
traditional gardens for her work in Oconomowoc. “Sometimes, we had to find similar alternatives to the English plants because the climate is different in
Wisconsin,” Rita says.

Realizing the extent of the work ahead of her, in 2000 Rita moved from her recently acquired position in the purchasing department into a solely gardening
position. She worked four to six hours per day, five days per week from March until November on her life’s passion of transforming the gardens to their
full potential, which was finally reached in 2001. “Early on as a child, I read hero stories and I really wanted to do something to make a difference in
this world, and I truly didn’t know that this was it until it was done,” she says.

Working in the gardens wasn’t just smelling the roses. The biggest challenge Rita faced was getting water access in the gardens. Before a pump was
installed in 2012, she and other volunteers had to haul hoses to the gardens.

Statue dedicated to Rita Nolte.

Rita’s Final Reflection

Volunteers and patients not only helped build the gardens, but many have experienced the healing properties of nature that Rita stands by. She says one
patient told her, “Pulling these weeds is like pulling the trouble out of my life.”

Another patient made discoveries about her own perfectionisms by working in nature. Rita notes, “She learned some plants die no matter what you do, and
that’s not failure, that’s just the natural life cycle of a plant,” says Rita. “You can do the best you can and things don’t always turn out. She knew the
gardens were still beautiful even though they may have had a few weeds or dead flowers.”

Rita credits her passion and knowledge of gardening to the teachings of her mother, grandmothers and grandfather. Regardless of the amount of time and work
she put into the gardens at Rogers Memorial Hospital, she insists,

“The real story is the garden, I just happened to be in it and it was my privilege.”

“Anxiety disorders are quite common among youth and adults and these
disorders frequently co-occur with disordered eating behaviors,” says Eric Storch, PhD,
clinical director of Rogers Behavioral Health–Tampa Bay and a Morsani College of Medicine professor. “Although exact prevalence rates are difficult to
specify for many reasons, we receive many calls from individuals seeking treatment for comorbid eating and anxiety symptoms.”

Matthew Brown, DO, child and adolescent psychiatrist of Rogers Behavioral Health–Chicago, explains that disordered eating habits can develop from a person’s fears. “Many
eating issues stem from some sort of anxiety, such as feeling too fat to be loved, nervous that he or she will never be loved or desiring to be the
‘perfect’ weight,” he says. “Many eating disorders are about control and control tends to be driven by anxiety.”

But do anxiety disorders always revolve around food? “Youth and adults presenting for intensive treatment of anxiety disorders at our regional locations
display a wide variety of difficulties. These difficulties range from social difficulties; to fears of specific places, people or things; to nearly
anything imaginable,” says Joshua Nadeau, PhD, clinical supervisor of eating disorder
and obsessive-compulsive disorder and anxiety disorder services at Rogers–Tampa. “Eating disorders—that is, anxiety manifesting as disordered
associations with weight, body shape, or eating habits—are one example of impairment related to anxiety.”

Dr. Storch explains that there currently is not enough research in the field to explain the cause of comorbid anxiety and eating disorders. “To some
extent, we focus very little upon the ‘why’ of the disorder and very much upon the ‘what now’ in terms of setting goals and helping our patients to reach
them,” he says. “Our treatment program focuses upon providing skills training, reducing ‘maintaining factors’ (those things in your environment that
reinforce disordered eating behaviors) and providing ample opportunities for practicing the adaptive skills in multiple settings.”

According to Dr. Storch, it’s important that comorbid conditions like eating disorders and anxiety are treated at the same time. “It is not enough to
simply change the specific eating disorder behaviors, as the incorrect thought patterns associated with anxiety will more than likely manifest in other
areas, and decrease the patients’ motivation for change in the future,” he says. “Our treatment of eating disorders and comorbid anxiety addresses the full
range of complexity that people with these problems experience with the goal of healthy lifestyle, happiness and improved quality of life.”

Rogers offers one of a few eating disorder programs that practice not only evidenced-based treatment for eating disorders, but we also have experts in
evidenced-based treatment for anxiety as well. “Here we are able to treat the whole patient with the goal of placing them in control of their own lives and
teaching them that they can be healthy and they can be successful if they are willing to invest in themselves,” says Dr. Brown.